AdoptionForm Step 1 of 7 14% Animal name*Please provide the name of the animal you would like to adopt or give a description of the type of animal you are looking to get pre-approved for. About YouName* First Last Email* Enter Email Confirm Email Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code County*e.g. Cumberland, York, Dauphin Primary Phone*This is a*mobile phonelandlineSecondary PhoneThis is amobile phonelandlineHave you ever adopted from HOPE before?*YesNoPlease list the name(s) of dog(s) previously adopted from HOPE.* About Your HomeDescription of residence*HouseApartmentTownhouseMobile HomeOtherDo you live with your parents?*YesNoDo you have a fenced yard?*YesNoWhat type of fence?*Wood/Wire/PVC 4ft.Wood/Wire/PVC 6ft.Electronic/InvisibleDo you*Own your homeRent your homeOwn home but rent lotLandlord informationPlease provide the following information about your landlord or lot ownerName* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone* Household InformationPlease provide the following information for all persons in the household, starting with yourselfHow many people live in your household, including yourself?*Please enter a number from 1 to 10.Your Name First Last Your Date of birth* Date Format: MM slash DD slash YYYY Your Age*HH Member 2 Name* First Last HH Member 2 Date of birth* Date Format: MM slash DD slash YYYY HH Member 2 Age*HH Member 3 Name* First Last HH Member 3 Date of birth* Date Format: MM slash DD slash YYYY HH Member 3 Age*HH Member 4 Name* First Last HH Member 4 Date of birth* Date Format: MM slash DD slash YYYY HH Member 4 Age*HH Member 5 Name* First Last HH Member 5 Date of birth* Date Format: MM slash DD slash YYYY HH Member 5 Age*HH Member 6 Name* First Last HH Member 6 Date of birth* Date Format: MM slash DD slash YYYY HH Member 6 Age*HH Member 7 Name* First Last HH Member 7 Date of birth* Date Format: MM slash DD slash YYYY HH Member 7 Age*HH Member 8 Name* First Last HH Member 8 Date of birth* Date Format: MM slash DD slash YYYY HH Member 8 Age*HH Member 9 Name* First Last HH Member 9 Date of birth* Date Format: MM slash DD slash YYYY HH Member 9 Age*HH Member 10 Name* First Last HH Member 10 Date of birth* Date Format: MM slash DD slash YYYY HH Member 10 Age* Current and past petsHave you ever had primary care and financial responsibility for a pet before?*YesNoPlease list the name(s), breed(s) and age(s) of all animals for whom you have had financial responsibility in the last 5 years. If deceased, please indicate the date of death.*Do you currently have any pets?*YesNoAre all of your current pets spayed/neutered?*YesNoIf you currently have a dog, or have had in the past, have you treated them with heartworm preventative?*YesNoN/AWhat brand and variety of food do you plan to feed your new pet?*e.g., Purina Pro Plan SelectsWhere do you keep your current pets?*InsideOutsideBothPlease explain your "Both" choice above:*Do you currently have or have you recently had any dogs or puppies with the Parvo or Corona Virus?*YesNoHow do you intend to keep this pet separated from the infected pet(s)?*For all current and deceased pets (within past 5 years), please provide the NAMES, ADDRESSES and PHONE NUMBERS of all Veterinarians used in this timeframe.*Have you ever surrendered or rehomed a pet for any reason?*YesNoPlease explain why and where the pet is now.*Under what circumstances would you give up a pet?* Plans for this PetWhere do you intend to keep this pet?*InsideOutsideBothPlease explain your "Both" answer to the last question.*Where will this animal sleep?* Crate Cat or dog bed Family member's bed Basement Garage Outside kennel How long will this pet be alone each day (crated or otherwise unattended; include time before and after a break if someone comes home for lunch)?* : HH MM If you currently have dog(s), how are they exercised each day and how do you plan to exercise your new dog each day (include approximate amount of time and distance).*Do you have any family members with allergies or other health conditions that may impact the outcome of this adoption?*YesNoPlease explain your "Yes" answer to the previous question.*Veterinarian's InformationPlease provide the following information about the veterinarian where you plan to take this pet.Vet Hospital/Clinic Name*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone*FaxReferencesPlease provide following for 2 character references who do not live with you. (At least one must be a non-family member/significant other). Ideally, your references will have been in your current home, be familiar with your living situation and with your lifestyle.Ref #1 Name* First Last Ref #1 Phone*Ref #1 Email Ref #1 Relationship*Ref #2 Name* First Last Ref #2 Phone*Ref #2 Email Ref #2 Relationship* Briefly explain why you can provide the best home for this animal.*Adopting an animal is a big responsibility. The animal for which you are applying will be totally dependent on you for all of its needs for the rest of its life. This includes medical care and training.On an annual basis, what do you think an animal's medical care costs?*How would you handle a medical emergency or long term illness should your pet require extensive veterinary care or treatment?**Are you willing to make a life-long commitment to this animal?*YesNoI certify that all information in this application is true. Furthermore, I understand that if the information contained herein is found to be false, my application will be voided and any pending adoption refused. I agree CommentsThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.